Download “chairwork” in psychotherapy

Psychotherapy: Theory, Research, Practice, Training
2004, Vol. 41, No. 3, 310–320
Copyright 2004 by the Educational Publishing Foundation
0033-3204/04/$12.00 DOI 10.1037/0033-3204.41.3.310
DIALOGICAL ENCOUNTERS: CONTEMPORARY
PERSPECTIVES ON “CHAIRWORK” IN PSYCHOTHERAPY
SCOTT KELLOGG
The Rockefeller University
This article looks at the use of
“chairwork” (2-chair and “empty”
chair) dialogues through the lens of 5
psychotherapies: Gestalt,
process-experiential therapy, redecision
therapy, cognitive–behavioral therapy,
and schema therapy. Many clinical
examples are provided, and they are
organized into 4 overlapping groups:
(a) internal in focus; (b) external in
focus; (c) conflictual, that is, whether
they involve the replaying of difficult or
traumatic scenes from the past; or (d)
corrective, which means that the
emphasis is on replacing maladaptive
cognitions or schemas with ones that
are healthier. A potential foundation
for Gestalt and cognitive–behavioral
integration is proposed on the basis of
the idea that gestalts are schemas (I. G.
Fodor, 1996) and that chairwork is
actually a form of cognitive
restructuring (D. J. A. Edwards, 1989).
The use of chairs in therapeutic dialogue, or
“chairwork,” is a powerful, effective, and creative intervention for psychological change and
transformation. The purpose of this article is to
outline contemporary visions of how chair dialogues can be used as seen through the lenses of
Scott Kellogg, Laboratory of the Biology of Addictive Diseases, The Rockefeller University.
Correspondence regarding this article should be addressed
to Scott Kellogg, PhD, Box 171, The Rockefeller University,
1230 York Avenue, New York, NY 10021-6399. E-mail:
[email protected]
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several psychotherapeutic schools. The patterns
and structures that emerge from this exploration
can help guide therapists in their use of this approach while laying the foundation for future
developments.
Chairwork, which originally developed as a
technique used in psychodrama (Carstenson,
1955; Fowler, 1992; Lippitt, 1958; Perls, 1973),
is probably most readily associated with Fritz
Perls (1973, 1975) and Gestalt therapy, with
Esalen and the “hot seat” (Perls, 1969a, 1969b).
If chairwork is seen as being only in the province
of the Gestalt therapists, then the future of this
intervention may be somewhat restricted. While
Gestalt therapy has spread throughout the planet
with Gestalt institutes in major cities (Greenberg
& Brownell, 1997), a recent Delphi study on the
future of psychotherapy (Norcross, Hedges, &
Prochaska, 2003) found that experts in the field
believed that the influence of Gestalt therapy
would continue to decline over the next 10 years.
In comments that were germane to this article, the
panel of experts believed that cognitive–
behavioral and integrative therapies would continue to grow in prominence and importance, and
they also noted that the newer therapies tended to
incorporate valuable aspects of earlier therapeutic
schools—meaning that vitally important ideas
were not being lost to the field.
The Five Psychotherapies
This article primarily looks at chairwork
through the lens of five psychotherapies: Gestalt
therapy (Baumgardner, 1975; Perls, 1969a, 1973,
1975); process-experiential therapy (Elliot,
Davis, & Slatick, 1998; Greenberg, 1979; Greenberg, Rice, & Elliot, 1993; Greenberg, Watson, &
Goldman, 1998; Wolfe & Sigl, 1998), which is a
combination of Gestalt, experiential, and clientcentered therapies; redecision therapy (Goulding,
1972; Goulding & Goulding, 1997; Lennox,
Contemporary Perspectives on “Chairwork”
1997), which represents a uniting of transactional
analysis and Gestalt therapy; cognitive–behavioral therapy (Goldfried, 1988, 2003; Samoilov &
Goldfried, 2000); and schema therapy (Young,
Klosko, & Weishaar, 2003), which incorporates
aspects of cognitive–behavioral, psychodynamic,
and Gestalt/experiential therapies. A full description of each of these approaches and their panoply of interventions is beyond the scope of this
article. Instead, this article’s focus is centered on
the way each of these perspectives conceives of
the use of chairs.
Therapeutic Paradigms
Each of the therapies has shared and unique
visions of the therapeutic process, the desired
goal or outcome, and the role of the therapist.
These differences can be clearly seen in the ways
that chairwork is undertaken and understood. In a
chapter with great relevance to this article,
Greenberg, Safran, and Rice (1989) explored the
differences between experiential and cognitive–
behavioral therapies. They described the experiential therapies as facilitating; the goal was to
help the patient grow in awareness so that whatever was unresolved, whatever was necessary for
healing and transformation, would emerge from
within. The cognitive–behavioral therapies were
described as modifying; here, the therapist is actively seeking to make changes in the patient’s
inner world.
An examination of the five therapies reveals a
further delineation of the modifying group. While
the Gestalt and process-experiential therapies are
facilitating, among the modifying approaches, redecision therapy is a conflict therapy, Goldfried’s
(1988) rational restructuring approach is a corrective therapy, and schema therapy is both a
conflict and a corrective therapy. The conflict
therapies, typically through the use of chairs and
imagery, bring the patient back to a dysfunctional
or traumatic scene or series of scenes from childhood. In redecision therapy (Goulding & Goulding, 1997), it is believed that the child is receiving a poisonous message from a parent or another
powerful figure, a message that is called an injunction. This is conveyed through the words and
actions of this figure. The child, as a means of
survival, makes a decision to accept the pathological injunction. This sets into play a dysfunctional script or a lifelong pattern of problematic
behavior. Using chairs and imagery, the patient is
brought back to a scene that connects to the original injunction and acceptance decision. The patient now confronts the parent or pathogenic figure or figures and tells them that he or she will no
longer accept the injunction and the patient will
now live his or her own life, in defiance of the
figure, if necessary.
In schema therapy (Young et al., 2003), the
patient is also thought to have been through a
series of traumatic or pathogenic situations.
These experiences can lead to the development of
early maladaptive schemas. Schemas are thematic structures “comprised of memories, emotions, cognitions, and bodily sensations” (Young
et al., 2003, p. 7) that serve as a blueprint for the
child’s world. Again, while they may have had a
survival value for the child in a dysfunctional
situation, they typically impair later functioning.
They are also seen as being a core component of
the Axis II disorders as well as many Axis I disorders—especially those that are recurring. Patients often experience schemas as upsetting
memories. Chairwork and imagery are used as
ways to rework them. When the patient and therapist replay these scenes, the therapist will often
confront abusers first while nurturing the image
of the patient as a small child. The therapist will
also help the patient confront abusers in the
“empty” chair. It is this active and directed attack
on people who had wronged patients that allows
these two approaches to be labeled as “conflict
therapies.”
Goldfried (1988, 2003; Samoilov & Goldfried,
2000) has written on the use of chairs in his rational restructuring/cognitive–affective therapy.
Like other cognitive therapists, he is trying to
replace dysfunctional thinking with more adaptive thinking. He advocates the use of chairs because he is aware that cognitive shifts are more
likely to take place if there are higher levels of
affect, and he believes that the use of chairs engenders greater levels of emotion arousal. In his
model, one chair represents the dysfunctional
thinking pattern, while the other represents the
healthier alternative—an alternative that may be
jointly created by the therapist and the patient.
Schema therapy also uses chairs to dispute the
validity of the schemas, and, in this regard, it is
also a corrective therapy.
What these therapies share in common is the
belief that events from the past continue to play a
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detrimental role in present-day functioning. Illustrating this, Tobin (1976) wrote the following:
For example, one man as a child was continually humiliated
and rendered helpless by his father. To express his rage toward his father would have meant his own destruction. Today
he continually attempts to finish this situation by provoking
authority figures into attacking him and then attacking back.
(p. 374)
Therapist Roles
The differences between the facilitating approach, on the one hand, and the modifying approaches, on the other hand, can be clearly conveyed in the dramatically different perspective on
the therapist’s role. Greenwald (1976), writing
from a Gestalt perspective, described the psychotherapist’s work in this way:
The therapist rejects any kind of authority position toward the
person with whom he is working. The therapist does not
attempt to lead, guide, advise, or in other ways take away
the other person’s responsibility for himself [or herself].
Rather, his attitude is that each person knows best what he
needs for himself and how to get it; even when he is stuck, he
is more capable of finding his solutions than anyone else. (p.
278)
This view stands in stark contrast to that of
Goulding and Goulding (1997), who see the
therapist in a much more active role:
In redecision therapy, the client is the star and the drama is
carefully plotted to end victoriously. . . . The therapist is the
director of the drama, writer of some of the lines, and occasionally interpreter. . . . We do not want to produce tragedies—we are interested in happy endings. (p. 177–178)
In an earlier passage, Goulding and Goulding
(1997) clearly delineated the goal of the therapy
when they said, “We are focused exclusively on
what the client needs in order to renounce victimhood” (p. 168).1
Dimensions of Dialogue
Analyses of case scenarios support the use of
several dimensions in attempting to understand
chairwork. There are three overarching dimensions that emerge in the use of chairs—external,
internal, and corrective—and each of these has a
number of subthemes.
External Dialogues
External dialogues frequently consist of what
Greenberg (Greenberg et al., 1993; Paivo &
Greenberg, 1995) has referred to as “unfinished
business.” This typically occurs when an indi-
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vidual feels that events that took place in the past
with significant others or important people in
their lives are not resolved (see also R. Elliott et
al., 1998).
Goulding and Goulding (1997) described
many cases that fit this pattern. As noted above,
their patients have typically gone through a series
of traumatic experiences with a family member
or another significant individual. This led them to
make a decision that served as the nucleus of an
ongoing pattern of troubled or diminished functioning. In therapy, the patient imagines a scene
from his or her past that relates to the difficulties
that he or she has been having, and this serves as
the basis of the work. The dialogue with the person in the empty chair is confrontational, and the
goal is for the patient to repudiate the original
maladaptive decision and announce his or her
voluntary adoption of a new decision, a healthier
perspective on life.
A patient with workaholic tendencies remembered a situation in which, as a child, he asked his
father if he could sign up for a Little League
team; his father told him that he could not because he had to help him work on the farm instead. In the chairwork encounter, he again asked
his father if he could join the team, and when his
father told him that he could not, he defied his
father and said that he would do it anyway. He
also put his father in the chair, and, in a two-chair
dialogue, asked his father why he was that way.
After his “father” spoke of the poverty and desperation that he had been faced with, the patient
affirmed that while that may have been true for
his father, it was no longer true for himself. He
then went on to restructure his life in such a way
that he had more time for play and selfdevelopment instead of constantly working
(Goulding & Goulding, 1997).
In these dialogues, sometimes the parent figure
will change and support the patients’ new decision and sometime they will not. If not, Goulding
and Goulding (1997) encourage the patient to
1
In my opinion, Perls, in the transcripts of his work at the
end of his career (Perls, 1969a, 1973, 1975), appears to have
been more of a modifying than a facilitating therapist. I feel
that he worked with a therapeutic agenda that was often focused on polarities and centeredness. This therapeutic “activism” may have put him at odds with other members of the
Gestalt community (i.e., From, 1984), who could more clearly
be defined as taking a facilitating approach.
Contemporary Perspectives on “Chairwork”
make the decision in defiance of the parent. They
then ask the patient to find other supportive figures (such as other family members or teachers)
who will support the patient in the change process. These individuals are then put in the chair,
and they express their support for what the patient is doing. Another variant is to have patients
become a new, affirming father or mother to
themselves. This new “parent” takes a chair and
talks to him- or herself as the child in the original
scene, supporting the child in changing his or her
life (Goulding & Goulding, 1997). As Mary
Goulding (Goulding & Goulding, 1997) told a
patient named Abe, “Tell you what, make up a
new father. . . . Be the kind of father you want
now. . . . and tell Abe what you enjoy about him”
(p. 77). In this way, she was trying to create more
positive introjects. In the language of transactional analysis, she was strengthening the nurturing parent at the expense of the critical parent; in
schema therapy language (Young et al., 2003),
she was developing the healthy parent and diminishing the power of the punitive parent.
Not infrequently, these scenarios involve traumatic or humiliating situations. In situations in
which men are reworking experiences of having
been bullied, more than one empty chair can be
used so that each persecutor can be addressed
personally. Using a schema therapy approach,
this may be combined with imagery techniques in
which patients can relive an earlier scenario; this
time, however, they are given a weapon so that
they can defend themselves directly or, if that
feels too difficult, their adult selves or the therapist steps in and defends the child self.
As noted above, Goulding and Goulding
(1997) have some clear goals behind their interventions. They want to “turn the scene from [a]
tragedy to a drama that ends well” (p. 168). It is
interesting to note that they emphasize the crucial
importance of the patient making a decision to
change. They feel that patients who are prone to
blaming others actually want the other person to
change their behavior; this, however, will not be
therapeutic.
This belief underlies Goulding and Goulding’s
(1997) work with people who have suffered from
sexual and physical abuse. The structure that they
use takes this form:
1. The patient describes an abuse scene from
the perspective of an outside observer.
2. The patient and the therapist then discuss
the scene to clarify the details.
3. An empty chair is then brought in for the
abused “child,” and the patient and abused
child have a two-chair dialogue about the
experience.
4. The next step is to have the child relive the
traumatic scene; the child tells the story as
he or she experienced it. As in schema
therapy, if this is too overwhelming, the patient may bring in a protective figure as support (the therapist, an adult version of one’s
self, an armed protector), and he or she is
also allowed to leave the scene at any time.
5. The abuser is then put in the empty chair
and is confronted. In this scenario, the perpetrator is not allowed to change. He or she
is not allowed to apologize or promise to
behave differently. Again, this is because
the goal is to have the patient change. The
patient then clearly says how he or she will
live life, a life that will be created in defiance of what the abuser did.
Examples of redecisions include (a) “From now
on, I am going to find trustworthy people, and
I will trust them. Everyone is not like you.”; (b)
“I enjoy sex today in spite of what you did to
me. You are no longer in my bed.”; and (c) “I
can laugh and jump and dance without guilt, because my fun didn’t cause you to rape me! It was
your perversity!” (Goulding & Goulding, 1997,
p. 248).
Not surprisingly, these scenes may need to be
revisited a number of times before this kind of
resolution can take place. Goulding and Goulding
(1997) emphasized that no matter what happened
or what the children did, all guilt lies with the
perpetrator. If the patient has difficulty with feelings of guilt, the therapist will organize a twochair dialogue with one chair centered on “I am
guilty” and the other chair centered on “I am not
guilty.” The ensuing dialogue will help resolve
this issue.
In the case of emotional abuse, patients fight
back in the scenes and repudiate the toxic messages that are being given to them. They are encouraged to be self-affirming. Unlike in cases of
physical and sexual abuse, sometimes the figures
are put in the chair so that the patient can better
understand what drove them to behave that way
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and how they may have been projecting their own
issues onto the patient.
Using combinations of imagery and chairwork,
Young et al. (2003) also has patients challenge
parental figures, other figures from their past, and
people in their current life situation. This is done
to help break the strength of the schema, which
bears some similarity to the injunction–decision
dynamic.
Saying Goodbye
A specific form of unfinished business is “saying goodbye.” In this situation, the patient is
holding onto a relationship that has ended or no
longer exists. This connection serves to stifle the
patient’s growth and prevent further development. “The individual is still carrying around
much unexpressed emotion: old resentments,
frustrations, hurts, guilts, and even unexpressed
love and appreciation” (Tobin, 1976, p. 375). Not
only may people need to say goodbye to those
who have died or those whose relationships have
ended through such events as divorce or maturation, they may also need to release their connection to people who they do not know, such as
fantasy figures, geographical locations, careers,
personal dreams, and body parts if these investments are tying them to the past (Goulding &
Goulding, 1997).
In a Gestalt approach (Tobin, 1976), patients
are asked if they want to say goodbye to someone. Patients are then asked to invite the individual into the empty chair. They are asked what
they are experiencing as they imagine that person, and they are then encouraged to express
those feelings to them. Patients then switch chairs
and respond from the perspective of the deceased
or missing person. Keeping with the Gestalt emphasis on balance, it is of great importance that
patients ultimately express both the resentments
and the appreciations that they have for this person (Perls, 1975). “In almost every case there is
much emotion expressed—anger, hurt, resentment, love, etc.” (Tobin, 1976, p. 379). After this
dialogue has been concluded, the therapist asks
patients if they are ready to say goodbye. Sometimes they are willing to and sometimes they are
not; if not, the reasons for not doing so are explored and respected. While saying goodbye may
ultimately be a better solution, Tobin will allow
patients to defer making this kind of resolution,
but he does want them to take responsibility for
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making that decision. These scenarios may need
to be repeated over a number of sessions before
all of the issues can be worked through (Fodor,
1987).
Goulding and Goulding (1997) added to this
some specific procedures that they use when the
patient is saying goodbye to a deceased person.
They have the patient conjure up a scene from the
past in which the person was still alive. They do
not want him or her talking to the individual as a
dead person because this will weaken the attempt
to break the connection. They then ask the patient
to bring up the image of the person as dead and
say “you are dead” and “goodbye” (Goulding &
Goulding, 1997, p. 146).
Internal Dialogues
Internal dialogues are seen as useful when patients experience conflicts between different parts
of themselves, when they are of “two minds,” or
when they are “at war with themselves.” The distinction between internal and external is not hard
and fast in actual practice because some of the
disturbing internal voices are actual introjects of
parental figures (Perls, 1973). Dialogues that begin within a person may evolve into encounters
with people from the past. Nonetheless, there is a
class of situations that can be seen as primarily
internal, and clinical examples can be grouped
into several subcategories. Greenberg et al.
(1993) developed a therapy that specifically addresses the issue of inner conflict. They, as do
others in the Gestalt tradition (Fagan et al., 1976),
call these “splits.” Splits or conflicts often involve issues of desire and criticism or of desire,
fear, and criticism.
In many cases, these kinds of situations involve a harsh and critical voice (also known as
the “inner critic”). In Greenberg’s (R. Elliott &
Greenberg, 1997; R. Elliott et al., 1998; Greenberg et al., 1993, 1998) model, one chair embodies the critic, and the person speaks from this
perspective while in the chair. In the other chair,
which is known as the experiencing chair, the
person expresses how it feels to be criticized.
Greenberg et al. (1993) presented a case in which
a writer entered therapy suffering from, among
other things, depression and procrastination. In
the first series of chair dialogues, it became clear
that as the inner critic made its demands, she
retreated and avoided. In this way, her procrastination is a way of coping with these harsh inter-
Contemporary Perspectives on “Chairwork”
nal voices. Later in treatment, she was able to
have dialogue between the critic and the creative
side of herself. Here it emerged that the critic was
actually frightened of the creative side; she was
afraid that it would be overwhelming. The creative side, in turn, was fearful that the critic
would destroy her. When she was finally allowed
to emerge, it was often with such force that the
critic felt overwhelmed. In keeping with the Gestalt emphasis of integration, the patient reported
that she was beginning to be able to balance these
forces more effectively, that she could let the creative side out “in moderate doses” and end the
“either/or situation” (Greenberg et al., 1993, p.
309). While these splits often involve the use of
two chairs, they can involve more. One patient
developed a three-way dialogue between his developing assertive self; a critical, repressive, and
moralistic voice that he connected with his father;
and a fearful, anxious voice that he connected
with his mother. The resolution in a situation like
this could involve expressing one’s desires and
creating plans to act on them while also clarifying
one’s moral code and being cognizant of realistic
dangers that might exist.
Inner critic issues relate to Perls’ (1973) discussion about introjection versus assimilation.
Using Perls’ food metaphor, in introjection, the
child takes in the parent’s values as a whole,
without examining or questioning the contents.
With assimilation, there is a “digestion” process
in which the child retains those things that are of
value, importance, or use, and lets the rest go.
This is an integrative process, not an all-ornothing process. These dialogues enable this assimilation process to occur.
A second type of internal conflict is what Perls
(1973) called a retroflection and what Greenberg
(1979; Greenberg et al., 1993) called a “selfinterruptive split.” In this situation, one part of
the person does something to another part of the
person. Adapted examples from Greenberg
(1979) are “I judge myself”; “My difficulty is
that when I’m writing my paper, I’m also marking it”; and “I close off my feelings. I don’t allow
myself to feel” (p. 318). Again, the chairwork
involves putting the part that is interrupting in
one chair and the part that is seeking expression
in the other.
One may also be of more than “two minds”
about something. Young et al. (2003) developed
mode therapy, a variant of schema therapy, to
address the problems experienced by individuals
with severe character disturbance—particularly
borderline and narcissistic personality disorders.
They see the inner world of these patients as being populated by a number of inner figures including the vulnerable child, the angry child, the
detached protector, the punitive parent, and the
healthy parent. While Young et al.’s model involves a great deal of imagery work, there is also
an opportunity for these aspects of the self to
engage in dialogue so that they can work together
to both stop the damaging impact of the punitive
parent and function better in the world.
Another kind of inner dilemma can be found
around decisions. Indecision may reflect a conflict between two values (Fabry, 1988), or it may
be connected to different aspects of one’s past or
different projections about one’s future. Decisions to stay in a relationship or leave, to take a
new job or stay in the current one, to allow a child
to take a year off after high school or insist that he
or she attend college immediately may not have a
clear right or wrong answer. Having each chair
represent a side of the argument and having the
patient speak from that perspective (“I want to
stay in my current job,” “I want to take the new
job”) can help him or her get a clearer sense of
the emotional valence of each side as well as
some historical factors and introjects that may be
contributing to the indecision. “Is economic security the key issue or would it be better to pursue
that which I am passionate about?” Young et al.
(2003) believed that these conflicts may be connected to schemas or modes, and they frequently
gave names to the different perspectives or the
different selves that have emerged in the work.
This kind of approach is also applicable to procrastination. Goulding and Goulding (1997) reported a case in which a patient was procrastinating in the completion of her dissertation. As she
worked with “I want to write” and then “I won’t
write,” she realized that her anger at her parents
was playing a role in her lack of productivity. The
therapists, so as not to recreate her dynamic with
her parents, left it up to her as to whether she
would take action to complete the dissertation or
not.
One variable that can be of value here is that of
time (Goulding & Goulding, 1997). In the discussion on abuse above, the adult patient spoke to
himself when he was a child. In blocked decisionmaking situations, it can be helpful to speak
about the decision from a future time perspective;
that is, patients can speak about how their life is
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1, 5, 10, or more years from now, given that they
had made a specific decision. Patients can be
prompted to explore the impact of the decision on
specific areas of their lives. “You decided to take
that job and it is now 5 years later. How are you
doing financially? How is your family? Your
marriage? How is your health? Your sexuality?
Your sense of self? How do you feel about not
having made the other decision?” This can then
be done with the person sitting in the chair that
represented his or her decision to not take the job.
Another “internal” dialogue is one between the
individual and various body parts or diseases. In
an era in which there are both high levels of
cultural emphasis on body perfection as well as
on mind–body approaches to healing, this would
certainly appear to be an approach worth exploring. Young et al. (2003), again using a combination of imagery and dialogue, described a case of
a physician who had been in therapy for 20 years
in an attempt to address his concern that he had a
“migrating tumor” (p. 83). The patient was asked
to imagine the tumor and then have a dialogue
with it. The tumor said that the patient “has not
been doing his best work and is very bad. The
tumor is in his body to punish him. Paul [the
patient] had better work more conscientiously or
the tumor will strike him dead” (Young et al.,
2003, p. 83). The patient was then asked to bring
up an image of someone in his life who had
treated him the same way, and he recalled a situation in which he, as a child, was being confronted by his extremely demanding father. The
therapist concluded that “like the tumor, the father embodies Paul’s Unrelenting Standards
schema” (Young et al., 2003, p. 83).
Cummings (1999) wrote about the value of
Greenberg’s (Greenberg et al., 1993) processexperiential therapy in the treatment of patients
with genital herpes. First, she noted that
the two-chair intervention could be quite appropriate for helping clients resolve a number of internal, conflictual splits of
the self engendered by the disease: e.g., being a good versus
bad person, feeling out of control versus gaining self-control,
self-blame versus other blame. (p. 147)
This could include using the empty chair to speak
to the person who transmitted the disease to them.
It could also be used to practice telling a new
partner that they have herpes. In her case example, Cummings encouraged the patient to put
her herpes in the other chair and gave her the
opportunity to express what she wanted and
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needed to say. At the beginning of treatment, the
patient was deeply distraught about having herpes, but after some sessions that included the use
of chair dialogues, she felt that she had resolved
the issue and wanted to move on to other topics.
Corrective Approaches
While the dialogues here are also internal, the
structure is somewhat different. This use of chairwork is centered in the cognitive–behavioral approaches and is also found in schema therapy. It
grows out of the disputation tradition and involves the patient first expressing the dysfunctional thought or schema in one chair and then
countering it in the other. In a sense, this is the
most directed use of chairs, in that the therapist
may purposefully work with patients to create a
dialogue that counters the dysfunctional one.
Elliott and Elliott (J. E. Elliott, 1992; J. Elliott
& Elliott, 2000) have developed anthetic therapy.
Anthetic therapy, like Ellis’ rational–emotive behavior therapy (Ellis, McInerney, DiGiuseppe, &
Yeager, 1988), interweaves techniques for healing with the adoption of a humanistic philosophy
of life. The Elliotts believe that most psychopathology and psychic anguish comes from the “inner critic,” a punishing, judgmental inner voice
that seeks to control the individual. The core
technique in this work is the anthetic dialogue. In
a recent formulation of this approach (by Elliott
& Elliott), the patient describes his or her problem and the view of the inner critic is elicited.
This view is typically filled with “shoulds” that
the individual must follow or that lead to an experience of emotional pain. The inner critic is
then put in one chair and the patient sits in the
other and defies the critic by affirming that he or
she has the right to do whatever is being prohibited. By defying these critical injunctions, the patient regains the ability to behave freely, in a
manner based on his or her values and beliefs,
rather than out of fear.
Working from a cognitive–behavioral perspective, Goldfried (1988, 2003; Samoilov & Goldfried, 2000) made the case that both clinical practice and neuroscience are pointing to the importance of “hot” or emotionally laden cognitions in
the change process. He viewed the incorporation
of chairwork into cognitive–behavior therapy as a
way to more effectively change patients’ cognitive structures. Patients are invited to engage in a
dialogue between the “realistic” and “unrealistic”
Contemporary Perspectives on “Chairwork”
parts of themselves. They are also told that this is
a way of “taking what is internal and implicit and
making it external and explicit” (Goldfried, 1988,
p. 65). Again, the purpose is to enable the patient
to experience emotional arousal so that his or her
cognitive structure is more amenable to change.
Young et al. (2003) built on this tradition by
helping the patient engage in a dialogue with his
or her schema. Again, the schema is a traumarelated vision of the self and the world. The patient states the rules in one chair and then refutes
them in the other by providing contradictory evidence. Schema therapists will often encourage
the patient to take the role of the schema first,
while the therapist takes the healthy role. They
then reverse positions. Eventually, the patient can
enact both sides of the dialogue.
In a case example, a patient named Daniel was
presented. His background included alcoholism
in his father and sexual, physical, and emotional
abuse at the hands of his mother. His primary
schemas were Mistrust/Abuse and Defectiveness.
In short, he had doubts about his worth and he
was extremely mistrustful of others. He had a
goal of developing a long-term relationship with
a woman, but his schemas were interfering. In
their treatment of this patient, Young et al. (2003)
first worked with the patient to develop arguments against the schema. These were then put to
the test. An imaginary scenario was created in
which the patient saw an attractive woman at a
dance that he wanted to approach. First, the
schema side was encouraged to speak, and then
the healthy side took a turn. For example, the
patient, sitting in the schema chair, said, “Women
can’t be trusted, and they’re very unreasonable
and erratic, and it will be very difficult to figure
out just what to do. And I don’t think you can do
it.” He then responded in the healthy chair by
saying, “Women are people just like men are, and
they can be very reasonable, and they’re very
nice to be with” (p. 103). Young et al. emphasized the importance of having the healthy self
counter every argument of the schema side. The
patient goes back and forth until the healthy side
wins. It may be necessary to replay this scenario
many times before the patient fully incorporates
the healthy side. Repetition may be particularly
important because the patient may first accept the
new perspective intellectually but not emotionally; the goal is to have the patient eventually
accept it on an emotional level.
In a case with a similar structure, a patient
named Ivy was presented. She had a SelfSacrifice schema, which meant that she put the
needs of others before her own. This was done to
such an extreme that it was causing her to feel
angry and depressed. She was specifically angry
at her friend Adam because she felt that she listened to all of his problems while he did not show
an interest in hers. The dilemma was whether to
bring this up with him or not. She did chairwork
between the schema side, which said that she
needed to take care of him, and the healthy side,
which wanted a better balance, in which her
needs were met as well. As part of her change
process, she got angry at the schema. After finishing the dialogue, she did imagery work in
which she brought up childhood images of taking
care of her mother. She took further steps to let
go of the schema by telling her mother, “It cost
me too much to take care of you. It cost me my
sense of self” (p. 148).
Again, this approach contrasts with the “unfolding” perspective of the Gestalt or processexperiential therapists. Young et al. (2003) believe that the more troubled the patient is, the less
available are the healthy schema and mode
voices; in a sense, that is a core aspect of their
disturbance. This means that the patients are frequently unable to generate these kinds of dialogues on their own, and the therapist must work
with them to create and nurture these voices and
perspectives.
Dreams
Perls (1969a, 1973, 1975) strongly believed in
the importance of working with dreams as a way
to transformation. In his writings and in the transcripts of his work, he emphasized that the dream
is a creation of the individual and that each aspect
of the dream represents a part of the person. In
the therapeutic encounter, the patient is asked to
tell the dream in the first person as if it were
actually happening at the present moment. The
patient is then asked to change chairs and speak
from the perspectives of the various people, animals, or objects that occurred or played a role in
the dream. The goal here is integration. As Perls
(1975) said,
My dream technique consists of using all kinds of available
material that is invested in the dream. I let the people play the
different parts and, if they are capable of really entering the
spirit of the part, they are assimilating their disowned material. (p. 137)
317
Kellogg
A central aspect of this, which is discussed
below, is the eliciting of polarities or opposites
from the image within the dream. This is quite
clear from an account by Miller (1992), who described a dreamwork session by Perls in 1966:
I also remember my surprise as I watched a vastly overweight
mental health worker burst into sobs of deep grief within
moments after Perls asked her to imagine that she were a
beached whale. The whale had appeared in a dream about
marine life that she had just recounted. With prompting from
Perls, she seemed to melt before our eyes into a neglected
child alone in her room, bitterly lamenting the emptiness of
her existence. Usually this sort of Epiphany occurred, if at all,
only after a long spell in therapy. When Perls told her, as her
tears dried, to become the sea in her dream, her huge shape
seemed for a moment not just the visible burden of her selfhatred but an indication that she could be teeming with life.
(p. 2–3)
At their most stark, these are images of death and
life, of deprivation and abundance. Perls was
able to both acknowledge and help the mental
health worker experience her suffering while also
revealing her potential for growth and creative
possibility.
Redecision therapists also feel free to work
with dreams in an imaginative and fluid way. If a
dream is interrupted, they will have the patient
finish it in a positive and empowering fashion.
This is also true for dreams that recur. Massé
(1997), in an article on PTSD, wrote about a veteran who had a repeated nightmare in which he
was walking down a path while a Vietcong soldier was waiting to kill him. She created a chairwork scenario in which “he became a tree along
the trail, and told both himself and the Vietcong
that the war was over and they both could go
home now. Both agreed to put down their weapons and go home” (p. 206). That was the last time
he had that dream.
Integrative Possibilities
There have been a number of attempts to integrate cognitive–behavioral and Gestalt techniques and approaches. In addition to the work by
Goldfried (1988, 2003; Samoilov & Goldfried,
2000) and Young et al. (2003) discussed above,
Fodor (1987, 1996) described an “integrated Gestalt/CBT approach” (p. 212) in which she utilized a wide range of Gestalt and experiential
techniques, not just chairs. In turn, Wolfe and
Sigl (1998) incorporated some cognitive–behavioral techniques in their process-experiential
work.
318
More recently, Chadwick (2003) purposely
modified and integrated Greenberg’s (Greenberg
et al., 1993) two-chair approach within a schema
framework for the treatment of psychotic patients. This constructivist approach is based on
the idea that the lives of patients suffering from
psychosis are dominated by a negative schema, a
schema that develops both from their negative
life experiences as well as the criticisms of their
hallucinatory voices. Chairwork is done to help
create a positive schema, a schema that reflects
their healthy and good experiences and their affirming relationships. The goal is not to replace
the negative schema with the positive one but
rather to provide the patients with a more complex sense of self. This means that they will begin
to realize that they are not just “bad” but that they
are also “good” and that both schemas have
meaning. As they create a new self-construction,
they will begin to process their life experiences in
a richer manner, a manner that will hopefully
result in beneficial changes over time.
In terms of developing a working model for the
use of chairs in cognitive–behavioral therapy,
there are four core ideas that can be of use. The
first is that gestalts are schemas; these are merely
different words for the same phenomenon. As
Fodor (1996) wrote, “Schemas are dynamic
knowledge states, (gestalts) that organize experience” (p. 34).
This is a useful view, in part because it opens
up the possibility of using Young et al.’s (2003)
schema language when describing a patient’s gestalt framework. For example, in a Gestalt
therapy case presented by Zahm and Gold (2002),
the patient, Kim, became aware of a set of internal rules governing needs and emotions. “Kim
had learned not to reveal her feelings and emotional needs, but rather to focus on taking care of
her mother and siblings, and deal with any of her
needs by herself” (Zahm & Gold, 2002, p. 869).
These realizations are a very close match to the
schemas of Emotional Inhibition and SelfSacrifice (Young et al., 2003).
The next point is that the challenging and
transforming of dysfunctional schemas is a core
goal of both forms of treatment (Greenberg et al.,
1989). This can be conceptualized in several
ways. Both Beck (Dattilio & Freeman, 1992;
Young, Beck, & Weinberger, 1993) and Ellis et
al. (1988) share the view that the cognitive structure underlying emotional distress is typically
distorted and extreme. Therapy involves the
Contemporary Perspectives on “Chairwork”
modification of this pattern. For example, rational–emotive behavior therapy practitioners
may seek to move patients from stances based on
“musts” and “demands” to a state of “preferences.” Cognitive therapists may seek to move
patients from polarized or extreme thought patterns to more moderate and complex ones.
Perls (1973, 1975), in many respects, shared
the same goal. Perls believed that patients already
have everything that they need within them. Because of unfortunate life experiences, they have
disowned vital aspects of themselves and projected these abilities onto others. As can be seen
in the dreamwork example above, the goal of
therapy is to reclaim these projections, to integrate them into the self, and to achieve a state of
centeredness. Through the chair dialogues, the
patient is able to create an integrated synthesis
and an expanded repertoire of behavior. He or she
can then both work and play; he or she can exist
in solitude and be a member of a group.
In the transcripts of his work, Perls (1969a,
1973, 1975; Rosenberg & Lynch, 2002) is frequently using chairs to take the polar opposite
view as a way of reclaiming these energies. At
the beginning of one session, a patient said, “I’m
just aware of being frightened.” Perls, in a response to both the patient and the group that was
watching said, “So attack me right away! The
person who says he is frightened: you can be sure
some aggression is being projected somewhere.
So attack me!” She responded, “I am more aware
of feeling fear from—the group than you.” He
countered, “So attack the group! Tell them what
lazy bums they are” (from a Perls therapy transcript cited in Rosenberg & Lynch, 2002, p. 186).
In this process, Perls was helping the patient connect with and affirm an assertive aspect of herself
that she had denied and projected.
When we look at polarized thinking from both
perspectives we can see that, if patients feel that
they do not have access to the parts of themselves
that are strong or aggressive, then the consequent
vulnerability and anxiety may well fuel the rigidity and intensity of the dysfunctional beliefs. The
integrative possibility, then, is that therapists
could now use chairs to try to alter schemas and
dysfunctional thinking not only through the use
of the corrective techniques (J. E. Elliott, 1992;
Elliott & Elliott, 2000; Goldfried, 1988; Young et
al., 2003) but also through the use of the polarity
approach (Perls, 1973, 1975).
Given that gestalts are schemas and the schema
change is a central goal of the therapeutic enterprise, Edwards’s (1989) perspective is of central
importance. He made the third point that Perl’s
psychodramatic work with both chairs and imagery was, in fact, a form of cognitive restructuring.
This, in essence, ties together all of the different
visions of chairwork that have been reviewed in
this article.
Finally, a pragmatic or unifying metaphor for
the use of chairwork in psychotherapy may be
R. E. Elliott and Greenberg’s (1997) article on
voices and multivocality. Psychotherapy can begin to be seen as a process of strengthening,
transforming, and creating “voices,” of enabling
patients to engage in healing inner dialogues and
of helping them to create a new hierarchy within
themselves (Fosdick, 1977; Kellogg, 1993) so
that the more adaptive and empowering voices
have greater weight than the trauma-based or
dysfunctional ones.
Conclusion
Further dialogues among cognitive–behavioral
and schema therapists, on the one hand, and Gestalt, process-experiential, and redecision therapists, on the other hand, have the potential to lead
to even more creative and effective ways of
changing lives. While it seems highly probable
that imagery and chairwork, and the theories behind them, will continue to be reenvisioned by
the cognitive and schema therapists (as they have
been in this article), the field of psychotherapy
will be much richer for having integrated the wisdom of the Gestalt approach.
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